•Eligible commercially insured patients pay the first $50 for each outpatient dose of NULOJIX
•Program will cover the remainder of the copay, up to a maximum of $7,000 during a calendar year
•The Program will not cover the cost of any dosing procedure, any other healthcare provider service or supply charges or other treatment costs, or any costs associated with a hospital stay
•In order to receive the copay benefits, Patient or provider must submit an Explanation of Benefits (EOB) form within 180 days of receiving each dose of NULOJIX. The submitted form must include the name of the insurer, plan information, and show that the BMS medication supported by this program was the medication that was given
•Patient may be able to use the program to cover outpatient doses that occurred within 180 days prior to the date of enrollment